11 Sep 2013

NHS hospital death rates among worst, new study finds

Health and Social Care Editor

NHS chief Sir Bruce Keogh says he is taking very seriously figures revealed by Channel 4 News which show that health service patients are 45 per cent more likely to die in hospital than in the US.

Numerous reports and inquiries have revealed serious failings in the National Health Service. From the Bristol heart babies to Mid Staffordshire, fundamental problems with care have been exposed.

But what Channel 4 News can now reveal is previously unpublished data which shows just how badly our hospital mortality rates compare with other countries. And never more so than for the elderly.

The figures prompted Sir Bruce Keogh, medical director of the NHS, to say he will hold top-level discussions in a bid to tackle the problems.

“I want our NHS to be based on evidence. I don’t want to disregard stuff that might be inconvenient or embarrassing…I want to use this kind of data to help inform how we can improve our NHS,” he told Channel 4 News.

We still have too many patients dying in our hospitals when their relatives were expecting them to come home. Sir Bruce Keogh, NHS

“I will be the first to bring this data to the attention of clinical leaders in this country to see how we can tackle this problem.”

The data is the work of Professor Sir Brian Jarman, who pioneered the use of hospital standardised mortality ratios (HSMRs), as a way of measuring whether death rates are higher or lower than expected and which are adjusted for factors such as age and the severity of the illness.

It was by using HSMRs that Professor Jarman was able to identify the higher than expected mortality rates at the Mid Staffs trusts.

For more than a decade, Professor Jarman has also been collecting hospital data from six other advanced economy countries, adjusting them where possible to take into account the different health systems.

What he found so shocked him, he did not release the results. Instead, he searched – in vain – for a flaw in his methodology and he asked other academics to see if they could find where he might have gone wrong. They, too, could not find fault.

‘Shocking’ findings

So now he is releasing the findings. And they are shocking. The 2004 figures show that NHS had the worst figures of all seven countries. Once the death rate was adjusted, England was 22 per cent higher than the average of all seven countries and it was 58 per cent higher than the best country.

That meant NHS patients were almost 60 per cent more likely to die in hospital compared with patients in the best country.

“I expected us to do well and was very surprised when we didn’t,” Professor Jarman told Channel 4 News. “But there is no means of denying the results. They are absolutely clear.”

Read more from Victoria Macdonald on the NHS here 

Of course, that was nearly 10 years ago and the NHS has been through several reforms and had record amounts of money poured into it until recently.

When Professor Jarman projected the figures forward to 2012, the hospital death rates in all seven countries had improved – England’s faster than some.

However, it is still among the worst and has death rates 45 per cent higher than the leading country, which is America.

NHS medical director Sir Bruce Keogh told Channel 4 News: “The fact is we have a health service that is admired around the world, founded on the cradle to grave principle.

“But the other fact is, we still have too many patients dying in our hospitals when their relatives were expecting them to come home.”

Why is America doing better?

Because of confidentiality issues we are not allowed to name the other countries. But America stands out in the data for its lower mortality rates. So we went to find out why.

At the Mayo Clinic Hospital in Phoenix, Arizona, they are in the best two per cent in the country. It is an impressive hospital, with piano music playing in the lobby and sunshine streaming into the rooms.

And around the hospital are signs extolling their ethos: the patient comes first. To this end they have introduced a number of safety systems, including a check and recheck system between the pathology labs and the operating theatres.

For years they have had multi-disciplinary team rounds in which everyone from the consultant to the physio, from the nutritionist to the social worker is involved in the care of that patient.

It means better communication. Everyone is treated as an important part of the team, rather than deferring, in the traditional way, to the consultant.

Professor Richard Zimmerman, a neurosurgeon at the Mayo Clinic Hospital, acknowledges that this can be labour intensive with a dozen or more people involved in each round for each patient, but he said it is cost efficient in the end.

If you go to the States, doctors can talk about problems, nurses can raise problems and listen to patient complaints. Professor Jarman

“It is less expensive than having a lot of deaths and having admissions that last longer because you don’t do it right the first time,” he said.

Nevertheless, critics will say that it is difficult to compare the American hospitals with the NHS and it is true that in the US more money is spent on equipment, drugs, staffing levels. And it has an expensive, much-criticised insurance-based healthcare system.

And yet, American hospitals results are better. They have more per staff per patient, for instance. But what stood out at the Mayo was the attitude to mistakes or near misses. Staff are actively encouraged to report these. Whistleblowers are welcomed. Because they do not want these mistakes repeated.

“If you go to the States doctors can talk about problems, nurses can raise problems and listen to patient complaints,” Professor Jarman said.

“We have a system whereby for written hospital complaints only one in 375 is actually formally investigated. That is appalling, absolutely appalling.”

‘Appalling’ figures for elderly deaths

What is equally, if not more appalling, though are Professor Jarman’s HSMRs for the elderly (in this case classified as over 65).

For conditions which kill a large number of patients in hospitals and most often affect the elderly like pneumonia and septicaemia, patients are significantly more likely to survive in an American hospital.

Indeed, it was this data that Professor Jarman said encouraged him to speak more openly about his concerns about the NHS.

“It is not to say that we do not have some very good quality hospitals but we also have some very poor hospitals,” he said.

In Professor Don Berwick’s recent report on patient safety, he described HSMRs as a smoke signal – a warning that something may be wrong. Yet they do also raise questions that go to the heart of our cradle to grave care.

Are elderly people overlooked, treated with derision, even, that they die so much more easily in our NHS than elsewhere? And have we settled for mediocre when we could and perhaps should have the best?

Watch the Channel 4 News Cradle to Grave special report on Wednesday 11 September at 7pm